{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T22:16:15Z","timestamp":1788041775559,"version":"build-2784847793"},"reference-count":44,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Journal of Sports Medicine"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Pitching-related shoulder and elbow injuries continue to rise in baseball despite workload restrictions and biomechanics-informed coaching.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To evaluate associations between arm slot and shoulder\/elbow injured list (IL) time-loss burden and performance in Major League Baseball (MLB) pitchers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Cohort study; Level of evidence, 3.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Publicly available data were aggregated for 927 MLB pitchers who threw \u22651000 pitches during 2020 to 2025 and had arm angle data available from the MLB Hawk-Eye tracking system. Arm slot was defined as the throwing-arm angle relative to horizontal at ball release and averaged per pitcher (mean \u00b1 SD, 39.0\u00b0\u00b1 10.9\u00b0). Based on the distribution of arm slot values in the cohort, pitchers were categorized as sidearm (&lt;33.5\u00b0; n = 255), three-quarters (33.5\u00b0-44.4\u00b0; n = 373), or overhand (&gt;44.4\u00b0; n = 299). Primary outcomes were cumulative shoulder+elbow, shoulder, and elbow IL days accrued during the 2020 to 2025 study period. Performance outcomes included run prevention metrics, FanGraphs \"plus\" metrics (Stuff+ reflects pitch quality indexed to league average), strikeout and walk rates, hard-hit percentage (frequency of high-exit-velocity contact), and expected fielding independent pitching (xFIP; pitcher-controlled run prevention estimate). Group comparisons used 1-way analysis of variance with Tukey testing. Continuous associations with performance metrics reaching group-level significance were assessed with linear regression. Injury burden was modeled using negative binomial regression with log (total pitches) and percentage of games started as covariates; the primary analysis additionally adjusted for Stuff+ and 4-seam fastball velocity to test for independent associations after accounting for established risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Pitchers accumulated 86,412 combined IL days (25,710 shoulder; 60,702 elbow). Shoulder injury burden increased linearly with more overhand arm slots, whereas combined and elbow burden were nonlinear, peaking within the overhand group (45\u00b0-57\u00b0). Per 1 SD (10.9\u00b0) toward a more overhand delivery, injury burden increased for combined (incidence rate ratio [IRR] = 1.09;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .01), shoulder (IRR = 1.11;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .002), and elbow (IRR = 1.08;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .03). After adjustment for Stuff+ and 4-seam velocity, arm slot remained independently associated with higher injury burden (IRR = 1.12-1.14; all\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). Performance profiles favored sidearm deliveries: per 1-SD more overhand slot, Stuff+ decreased (\u03b2 = \u22121.09;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001), while xFIP (\u03b2 = 0.05;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .02) and hard-hit percentage (\u03b2 = 0.50;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001) increased. Sidearm pitchers used fewer 4-seam fastballs\/cutters and more sinkers\/sweepers.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>In this MLB cohort, sidearm deliveries were associated with lower shoulder\/elbow time-loss burden, superior pitch quality, and lower hard-hit rates. Shoulder injury burden increased linearly with more overhand deliveries, whereas elbow burden followed a nonlinear pattern that peaked within the overhand range. These associations were independent of workload, velocity, and pitch quality. Arm slot may represent a clinically relevant marker of pitcher injury risk that warrants prospective study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23259671261470537","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:05:58Z","timestamp":1787756758000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Sidearm Deliveries Are Associated With Lower Shoulder and Elbow Injury Burden and a Favorable Performance Profile in Major League Baseball: A Cohort Study of 927 Pitchers (2020-2025)"],"prefix":"10.1177","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-5032-316X","authenticated-orcid":false,"given":"Morgan R.","family":"Dillon","sequence":"first","affiliation":[{"name":"Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8332-5131","authenticated-orcid":false,"given":"Michael A.","family":"Mastroianni","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Columbia University Irving Medical Center\u2013New York Presbyterian Hospital, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0623-2864","authenticated-orcid":false,"given":"Nicholas","family":"Frappa","sequence":"additional","affiliation":[{"name":"Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Manzi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Lenox Hill Hospital, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9960-3412","authenticated-orcid":false,"given":"Samuel I.","family":"Fuller","sequence":"additional","affiliation":[{"name":"University at Buffalo Department of Orthopaedics and Sports Medicine, Buffalo, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Curtis","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Columbia University Irving Medical Center\u2013New York Presbyterian Hospital, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank J.","family":"Alexander","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Columbia University Irving Medical Center\u2013New York Presbyterian Hospital, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Ablove","sequence":"additional","affiliation":[{"name":"University at Buffalo Department of Orthopaedics and Sports Medicine, Buffalo, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter N.","family":"Chalmers","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher S.","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Columbia University Irving Medical Center\u2013New York Presbyterian Hospital, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"e_1_3_2_2_2","unstructured":"Adler D. 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